Understanding self-insured claims

A self-insuring employer administers their own worker's compensation programs

Self-insuring (SI) employers administer their own workers’ compensation program using Ohio workers’ compensation laws and rules. If an injured worker files a workplace injury claim with a SI employer, the employer makes the initial determination and subsequent decisions regarding the medical treatment and procedures (medical allowances), and benefits (compensation or additional condition allowances).

Claim number assignment
Injuries resulting in seven or fewer calendar days of disability do not need a BWC claim number unless the employer denies the claim.

Paying for medical treatment
The SI employer will pay the fees for health-care services related directly to a workplace injury.

Prior authorization is usually required for medical services, such as hospital stays, consultations, surgery and physical therapy, except for in emergency situations.

The medical provider or injured worker must submit all medical bills to the SI employer within two years of the date of service to be considered for payment.

SI employers must pay medical bills within 30 days of receipt, unless additional information is needed or the bill is being denied.

If a health-care provider treats you for a condition not recognized in your claim, neither BWC nor your employer is responsible for payment. If your believe the condition is related to the claim, file a request with your employer to have the condition recognized. If your employer denies the request, file a Motion (C-86) with the Ohio Industrial Commission and attach copies of the employer’s decision.

Benefits
To learn more about the workers' comp benefits to which you are entitled, speak with your employer.

Rehabilitation services
If you're interested in vocational rehabilitation services, you should also speak with your employer directly. SI employers must provide rehabilitation services that are equal to or greater than the services provided by BWC.

Disputing a claim
If there's a dispute between you and your employer, either of you may file a Motion (C-86) to request a hearing before the IC.

Resolving issues
Injured workers of SI employers should speak with their employer first when they have questions or concerns. BWC's self-insured department is also available for assistance.

If the employer denies a medical bill, file a Motion (C-86) to request a hearing before the IC. The IC is a separate agency from BWC and hears all disputed issues in the claim. A hearing will be scheduled within 45 days from the date of referral to the IC.